BACKGROUND Unrepresented patients are defined as patients who lack capacity and do not have surrogate decision makers. Nonemergent medical treatment of unrepresented patients is often not provided owing to lack of a surrogate or is delayed because of lengthy court proceedings resulting in increased suffering and increased length of stay. OBJECTIVE Development of an institutional policy that allows a multidisciplinary team to make medical decisions for unrepresented patients provides an ethically sound, legally viable, medically appropriate, and financially responsible solution. METHODS A retrospective review of deidentified bioethics logs over a 2-year period was conducted after the implementation of an Unrepresented Patient Committee policy. The primary outcomes were (1) total number of consults received and (2) average time to convene committee meeting. RESULTS There was a substantial increase in unrepresented consult requests from an average of 2 requests per year before 2015 to 23 requests in 2015 and 20 requests in 2016. The committee meetings were convened on average within 4.8 days of a consult request in 2015 and within 5.8 days in 2016. Implementation of this policy in lieu of a court petition led to a considerable reduction in the time for decision-making resulting in better clinical care and decreased length of stay with an estimated cost avoidance of $1,968,250 over the study period. CONCLUSION Implementing an Unrepresented Patient Committee policy has created an avenue for ethical and collective decision-making, improved quality and efficiency of medical care delivery, reduced length of stay, and decreased health care costs.

中文翻译：

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无代表患者的医疗保健决策的道德、同情和具有成本效益的方法：生物伦理质量改进项目

背景 无代表患者被定义为缺乏能力且没有替代决策者的患者。没有代理人的患者的非紧急医疗往往因缺乏代理人而无法提供，或因冗长的法庭诉讼程序而延误，导致痛苦增加和住院时间延长。目标 制定允许多学科团队为无人代表的患者做出医疗决定的机构政策提供了一种道德上合理、法律上可行、医学上适当且经济上负责的解决方案。方法 在实施无代表患者委员会政策后，对过去 2 年的未识别生物伦理日志进行了回顾性审查。主要结果是 (1) 收到的咨询总数和 (2) 召开委员会会议的平均时间。结果 无代理咨询请求大幅增加，从 2015 年之前的平均每年 2 次请求增加到 2015 年的 23 次请求和 2016 年的 20 次请求。委员会会议平均在 2015 年和 5.8 天的咨询请求后召开2016 年的天数。代替法院请愿的政策的实施导致决策时间的显着减少，从而改善了临床护理并缩短了住院时间，在研究期间估计节省了 1,968,250 美元的成本。结论 实施无代表患者委员会政策为道德和集体决策开辟了途径，提高了医疗服务的质量和效率，